When is a staging scan required for newly diagnosed brain lesions on CT? A multivariate logistic regression analysis.

PURPOSE: For patients with a new lesion on CT head (CTH) suspected to be a brain tumor, a staging chest, abdomen, and pelvis CT (CTCAP) is only warranted if a metastatic lesion is suspected. Unnecessary CTCAPs are often performed too early in a patient's journey due to poor patient selection. We sought to create a protocol to guide the selection of patients for CTCAPs based on their CTH findings. METHODS: Patients with suspected new brain tumors discussed at the neuro-oncology MDT at a tertiary neurosurgical center were reviewed. Patient demographics and CTH features were collected. For protocol creation, data was collected from July to December 2020, and predictor variables were identified using multivariate logistic regression. Candidate protocols were assessed in a protocol testing stage using similar data collected from January to June 2021. Sensitivity, specificity, and area under the curve (AUC) were computed for each protocol. RESULTS: Variables from the protocol creation stage (222 patients) were assessed in the protocol testing stage (216 patients). The most sensitive variables predicting metastatic disease were a previous history of cancer, multiple lesions, lesion < 4 cm, and infratentorial location. A protocol recommending a CTCAP based on the presence of one of these features has a sensitivity of 99.1% (AUC 0.704). CONCLUSIONS: Unnecessary CTCAPs are reduced if performed only if a patient has one of the four identified predictor variables.

Prognostic computed tomography Scores in traumatic brain injury.

BACKGROUND: Traumatic brain injuries represent a significant cause of morbidity and mortality worldwide and road traffic crashes account for a significant proportion of these injuries. It is one of the leading causes of death, especially among young adults, and, according to the World Health Organization, this will surpass many diseases as the major cause of death and disability by the year 2020 and lifelong disability is common in those who survive. It is also known as the silent epidemic. Many CT scan scoring systems for brain injury have been developed but none of them are validated. These scores are based on structural findings of CT scan to predict the prognosis. Marshall and Rotterdam are the two most widely used scoring systems. METHOD: This was an observational study with prospectively collected data. 903 consecutive patients with TBI. This study aimed to compare the Helsinki CT scoring system with the Rotterdam scoring system to find out the better score for the prognostic purpose by using the Glasgow outcome score. RESULTS: Helsinki CT scoring system was found to be the most accurate score among the others in predicting the outcome of the patient based on morphological findings in CT scan. These scores also guided us regarding the treatment plan and patients with the good prognostic outcome are usually treated aggressively. Also these scores guide clinicians whether to opt for a conservative approach or any intervention. CONCLUSION: In this study we compared, Rotterdam vs. Helsinki CT Scoring System. We observed that the Helsinki score was a better outcome predictor for TBI than the Rotterdam score and can be used as a single validated score in predicting outcome and guiding the treatment.

Gunshot Spinal Injury: Factors Determining Treatment and Outcome.

OBJECTIVE: Spinal gunshot injuries are devastating injuries with significant morbidity and mortality. The purpose of this study was to compare the varied neurologic presentations and radiologic findings with their outcomes after treatment. We applied the Thoracolumbar Injury Classification and Severity Scale and Subaxial Cervical Spine Injury Classification to see whether the management of gunshot patients was performed according to the severity of the scores. METHODS: Between 2011 and 2014, 150 consecutive patients with spinal gunshot injury were admitted and treated at Liaquat National Hospital and Medical College, Karachi. We assessed patients neurologically by using the American Spinal Injury Association (ASIA) Scale. The morphologic parameters of injury were measured with the Thoracolumbar Injury Classification and Severity Scale and Subaxial Cervical Spine Injury Classification. The patients were either conservatively or surgically treated, and the ASIA Scale was applied at 1, 12, and 24 months. RESULTS: In the study, the ASIA Scale was applied on admission, in which 39% were ASIA A, 9.8% B, 15.6% C, 12.3% D, and 28% E. ASIA A was most commonly seen in the thoracic region. Sixty-two percent of the patients were treated conservatively and 38% surgically. After we applied the thoracolumbar and cervical injury severity scores, 36 patients scored under the nonsurgical criteria, and 79 patients scored in the surgical criteria. Overall improvement was seen in 31% of the patients in whom thoracic region showed greatest progress. CONCLUSIONS: Patients with gunshot injury should be considered for surgery when there is potential for improvement, if there is persistent cord compression, or if there is deteriorating or incomplete neurology. Lumbar gunshot injury has a better outcome compared with thoracic followed by cervical injury.

Variation in Outcome in Tethered Cord Syndrome.

STUDY DESIGN: Fifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014. PURPOSE: To assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations. OVERVIEW OF LITERATURE: TCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult. METHODS: Fifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12-48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment. RESULTS: Eighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved. CONCLUSIONS: Outcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies.